If one lives in a small town that is less than 75,000, it is quite possible there is only a single source Local Surgical Center or surgical hospital. That sole source Local Surgical Center situation leaves the patient with several options if surgery is required. He/She can go to the sole source Local Surgical Center and hope for the best regarding surgical technology and a qualified surgeon, or he/she can go to a larger city or town where there will be many more choices in hospitals, surgeons, or local surgical centers. The decision must be based on relevant conditions, such as the urgency of the surgery, the level of skill necessary for the surgeon and the distance from the small town to the larger. In the event of an extreme emergency, often the patient has no choice, initially, but to be taken to the Local Surgical Center or perhaps even to a hospital that performs no surgery. In advance of such a situation, a potential patient would be wise to investigate the Local Surgical Center to learn of several things: Is the Local Surgical Center an integral part of a surgical hospital classified as a Level One Trama Center and if not Level One, what is its classification; Is the Local Surgical Center supported by some sort of Life Flight service and if not, where is the closest service; Is the Local Surgical Center fully certified by the Joint Commission for Administering Hospitals (JCAH); What is the reputation of the Local Surgical Center as defined by patients who have been there; What is the level of available staff, for example, is there a nursing or physician shortage; Does the Local Surgical Center have the most up-to-date equipment, and does it use current surgical technology, both for invasive testing and for performing surgery; and, Where would one go if the responses learned from previous questions were in whole or in part in the negative? Another issue one should consider is the possibility that the Local Surgical Center may have an excellent Emergency Room, but , if it is associated with a hospital, or surgical hospital, it may have a very bad in-patient situation such as patients die for no reason, the hospital is very dirty and patients are known to come down with infectuous diseases.